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Propranolol as first-line treatment of head and neck hemangiomas
Carine Fuchsmann1, Marie-Claude Quintal, Chantal Giguere
1Service d'Otorhinolaryngologie Pédiatrique, L'Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69600 Bron, France. carine.fuchsmann@chu-lyon.fr
Insights
Propranolol effectively treats infantile hemangiomas in the head and neck, especially when initiated early. Prolonged treatment prevents recurrence, making it a preferred first-line therapy.
Area of Science:
- Pediatric dermatology
- Vascular anomalies
- Pharmacology
Background:
- Infantile hemangiomas are common benign vascular tumors.
- Treatment options for head and neck hemangiomas have evolved.
- Early intervention is crucial for optimal outcomes.
Purpose of the Study:
- To evaluate propranolol's efficacy as a first-line treatment for head and neck hemangiomas in children.
- To present an optimized treatment protocol for infantile hemangiomas.
Main Methods:
- Multi-institutional retrospective study involving 39 children with head and neck infantile hemangiomas.
- Review of clinical records from two tertiary care pediatric centers.
- Propranolol initiated as sole treatment in 60% of patients, with a mean age of 4.1 months.
Main Results:
- Propranolol therapy led to significant lightening and reduction in 37 of 39 hemangiomas within 2 days to 2 weeks.
- Two cases (subglottic, nasal tip) showed poor response when treatment was delayed.
- Six recurrences were effectively managed with reintroduction of propranolol; prolonged treatment prevented relapse.
- Propranolol successfully treated hemangiomas in previously challenging locations (nose, lips, parotid area).
Conclusions:
- Propranolol is an effective first-line treatment for head and neck infantile hemangiomas, particularly when initiated early in the rapid growth phase.
- It is the recommended first-line therapy for orbit and larynx hemangiomas.
- The drug's efficacy and tolerability allow treatment of cases previously managed conservatively or with corticosteroids.
- Prolonged treatment beyond 12 months appears to prevent relapse.
Objectives:
To report the efficacy of propranolol as first-line treatment of head and neck hemangiomas in children and to present an optimized protocol for treating hemangiomas.
Design:
Multi-institutional retrospective study.
Setting:
Two tertiary care referral pediatric centers.
Patients:
Thirty-nine children with head and neck infantile hemangiomas were treated.
Main Outcome Measures:
Review of clinical records.
Results:
Propranolol was the sole treatment in 60% of patients and was started at a mean age of 4.1 months (age range, 1-11 months) for early interventions among 33 of 39 patients. Propranolol therapy resulted in lightening and reduction of hemangiomas at 37 of 39 locations within 2 days to 2 weeks. One subglottic hemangioma and 1 nasal tip hemangioma did not respond or showed only a partial response; in these patients, propranolol therapy was delayed and followed other treatment failures. After successful therapeutic regression, 6 recurrences occurred; when reintroduced, propranolol was again effective. Recurrences were avoided by prolonged treatment. Twenty-six hemangiomas occurring at locations for which corticosteroid treatment previously would not have been initiated (nose, lips, and parotid area) unless a complication had occurred were treated with propranolol and were rapidly controlled. The mean duration of propranolol therapy was 8.5 months. No instances of β-blocker discontinuation because of complications occurred, but propranolol was substituted by acebutolol in 5 patients because of trouble sleeping.
Conclusions:
Propranolol is an effective treatment of head and neck infantile hemangiomas, especially when started early within the rapid growth phase, and is first-line treatment of orbit and larynx hemangiomas. The efficacy and tolerability of propranolol led us to treat some hemangiomas in patients whom we previously would have observed rather than subject to corticosteroid therapy. Relapse was avoided if treatment was prolonged after theoretical involution (age 12 months). Questions remain about optimal dosing and age at treatment cessation.
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